title: Correlation between glycemic control and the incidence of peritoneal and catheter tunnel and exit-site infections in diabetic patients undergoing peritoneal dialysis.
abstract: BACKGROUND
  Diabetes mellitus, especially if complicated by poor glycemic control, portends an increased risk of infection. The significance of this association in the case of diabetic patients undergoing peritoneal dialysis (PD) has not been assessed.
  
  
  METHODS
  Using a retrospective observational design, we analyzed the association between glycemic control at the start of PD (estimated from glycosylated hemoglobin levels) and the risk of peritoneal and catheter tunnel and exit-site infections during follow-up in 183 incident patients on PD. We used the median value of glycosylated hemoglobin to classify patients into good (group A) or poor (group B) glycemic control groups. We applied multivariate strategies of analysis to control for other potential predictors of PD-related infection.
  
  
  RESULTS
  Groups A and B differed significantly in age, dialysis vintage, use of insulin, and rate of Staphylococcus aureus carriage. Neither the incidence (0.60 episodes in group A vs 0.56 episodes in group B per patient-year) nor the time to a first peritoneal infection (median: 42 months vs 38 months) differed significantly between the study groups. In contrast, group B had a significantly higher incidence of catheter tunnel and exit-site infections (0.23 episodes vs 0.12 episodes per patient-year) and shorter time to a first infection episode (64 months vs 76 months, p = 0.004). The difference persisted in multivariate analysis (adjusted hazard ratio: 2.65; 95% confidence interval: 1.13 to 6.05; p = 0.013). We observed no differences between the study groups in the spectrum of causative organisms or in the outcomes of PD-related infections.
  
  
  CONCLUSIONS
  Poor glycemic control is a consistent predictor of subsequent risk of catheter tunnel and exit-site infection, but not of peritoneal infection, among diabetic patients starting PD therapy.
authors.affiliation: Division of Nephrology, University Hospital A Coruña, and Health Sciences Faculty, University of A Coruña, A Coruña, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Rodríguez-Carmona
authors.affiliation: Division of Nephrology, University Hospital A Coruña, and Health Sciences Faculty, University of A Coruña, A Coruña, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Pérez-Fontán
authors.affiliation: Division of Nephrology, University Hospital A Coruña, and Health Sciences Faculty, University of A Coruña, A Coruña, Spain.
authors.forename: Andrés
authors.initials: A
authors.lastname: López-Muñiz
authors.affiliation: Division of Nephrology, University Hospital A Coruña, and Health Sciences Faculty, University of A Coruña, A Coruña, Spain.
authors.forename: Tamara
authors.initials: T
authors.lastname: Ferreiro-Hermida
authors.affiliation: Division of Nephrology, University Hospital A Coruña, and Health Sciences Faculty, University of A Coruña, A Coruña, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: García-Falcón
mesh_terms: D017677:Age Distribution; D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000209:etiology; D002408:Catheters, Indwelling / Q000009:adverse effects; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis*; D038321:Glycemic Index; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000379:methods; D010538:Peritonitis / Q000453:epidemiology* / Q000209:etiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D018709:Statistics, Nonparametric
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: Peritonitis; catheter tunnel infection; diabetes; exit-site infection; glycosylated hemoglobin; hyperglycemia